Should I ask my primary care physician for a cognitive assessment during my physical exam?

According to a March 2019 report by the Alzheimer’s Association, 82% of seniors believe it is important to have their thinking and memory checked, and about 94 percent of primary care physicians consider it important to assess all patients age 65 and older for cognitive impairment.

However, though there is the understanding between both seniors and primary care physicians about the value of early cognitive testing, the report found that just one in seven seniors (16%) reveal that they receive regular cognitive assessments for memory or thinking issues during routine health exams. This is very low in comparison to other routine tests, the report showed, such as blood pressure (91%), cholesterol (83%), vaccinations (80%), hearing or vision (73%), diabetes (66%) and cancer (61%).

"While it's encouraging to see that the vast majority of seniors and physicians understand the value of brief cognitive assessments, we're still seeing a significant gap in those that actually pursue, perform or discuss these assessments during routine exams," said Dr. Joanne Pike, chief program officer for the Alzheimer's Association. "Early detection of cognitive decline offers numerous medical, social, emotional, financial and planning benefits. But these can only be achieved by having a conversation with doctors about any thinking or memory concerns and through routine cognitive assessments."

Seniors are not always quick to discuss any cognitive impairment with their physicians. The Alzheimer’s Association’s survey report found that while half of all seniors (51%) are aware of changes in their ability to think, understand or remember, only 40% have ever discussed these concerns with their doctor.

It seems seniors are relying on their doctor to recommend cognitive testing as 93% of seniors in the report trusted that their doctor should be the one initiating the assessments. However, this is not the case. Fewer than half, or 47%, of primary care physicians stated that it is their standard practice to assess all patients age 65 and older for cognitive impairment. Just 26% of seniors reported having a physician ever ask them if they had any concerns about cognitive deficits without seniors bringing up the subject first.

“The findings indicate there are missed opportunities for seniors to discuss cognitive concerns and problems in the exam room,” said Pike. “We hope the report will encourage seniors and physicians both to be more proactive in discussing cognitive health during the Medicare Annual Wellness Visit and other routine exams.”

Almost all physicians taking part in the report survey indicated that the decision to assess patients for cognitive deficits was driven by reports of symptoms from the patient, a family member or caregiver. Physicians indicated that the primary factors in the decision not to assess cognition was due to lack of symptoms or complaints from the patient, lack of time during patient visit and general patient resistance.

Questions about Alzheimer's disease or related disorders can be sent to Dana Territo, the Memory Whisperer, owner of Dana Territo Consulting, LLC, at thememorywhisperer@gmail.com.